Flaccid vocal cords (3 of 4)
Dramatic lateral excursions due not only to bowing, but also flaccidity.

Flaccid vocal cords (4 of 4)
Eventual recoil towards midline, but cords never come into full contact before they are again thrown to their maximum lateral vibratory excursion, as in photo 3.

Flaccid vocal cords: Series of 3 photos

Flaccid vocal cords (1 of 3)
Open phase of vibration showing large amplitude in middle voice.

Flaccid vocal cords (2 of 3)
Maximum closed phase, but with persistent open area anteriorly (at arrow) If this area of exaggerated flaccidity oscillates independently, a rough quality is added to the voice.

Flaccid vocal cords (3 of 3)
Between open and closed phase, showing vibratory contact is aberrant.

Vocal cord bowing: Series of 4 photos

Vocal cord bowing (1 of 4)
Open phase vibration, strobe light. Notice the large amplitude of vibration. The wide lateral excursions suggest flaccidity, especially when this is seen in middle voice.

Vocal cord bowing (2 of 4)
Partially closed phase, strobe light. Notice that the anterior cords are more flaccid, with delayed return to midline contact. When this is seen, that anterior segment may vibrate independently and cause a rough, gravelly voice quality. The capillary ectasia, left vocal cord is an incidental finding an not related to the patient’s rough voice quality.

Vocal cord bowing (3 of 4)
Coming to closed phase, but with persistent anterior open segment.

Vocal cord bowing (4 of 4)
Closed phase of vibration, strobe light.

Flaccidity without bowing: Series of 4 photos

Flaccidity without bowing (1 of 4)
The patient exhibits typical symptoms of bowing/atrophy/flaccidity, but in this case there is little bowing or atrophy—primarily flaccidity is seen. In this view, the abducted vocal cords appear full, with no exaggeration of the ventricles. (The apparent asymmetry between the vocal cords is due to the viewing angle; both cords are the the same.)

Flaccidity without bowing (2 of 4)
Now seen under the strobe light, the amplitude of vibration of the vocal cords is excessive. These flaccid vocal cords lack the firmness to "recoil" back to the mid-line, until maximal separation of the cords is reached.

Flaccidity without bowing (3 of 4)
As the patient is reaching the closed phase of the vibratory cycle, the anterior cords are arriving late to closure, a typical finding with flaccid vocal cords.

Flaccidity without bowing (4 of 4)
Now at the maximum closed phase of vibration, a pinhole of incomplete closure is seen. In this case, there is no independent oscillatory vibration of the anterior segment of the vocal cord.

False cord phonation: Series of 5 photos

False cord phonation due to flaccid true cords (1 of 5): before false cords begin to vibrate
An elderly man, quiet by nature who uses the voice little, complains of weak, gravelly voice quality. This view of phonation, standard light, shows a slightly wider dark line of phonatory blurring. Also, the false vocal cords are overly approximated, but not yet participating in vibration (for that, see images 4 and 5).

False cord phonation due to flaccid true cords (3 of 5): before false cords begin to vibrate
Maximum closed phase shows the telltale residual opening at the anterior commissure (from this perspective, the lowermost end of the true cords), also a potent indicator of flaccidity.

False cord phonation due to flaccid true cords (4 of 5): after false cords begin to vibrate
When asked to produce louder voice, the false cords begin to participate in vibration, and a rough, gravelly superimposed “godfather” quality arrives. Notice that the true cords are in at least partial open phase of vibration.

False cord phonation due to flaccid true cords (5 of 5): after false cords begin to vibrate
Now the false cords are in open phase of vibration, and the true cords are in maximum closed phase of vibration, with the same residual opening anteriorly seen in photo 3. False cord phonation is not to be seen most accurately as primary here, but as a secondary result of effort necessitated by flaccid true cords.

Flaccidity: Series of 5 photos

Flaccidity (1 of 5)
Under strobe light, the vocal cords begin opening at the area of flaccidity anteriorly. The patient has a husky and gravelly voice quality (view here rotated 90 degrees counterclockwise).

Flaccidity (2 of 5)
Vibratory separation continues and is still greatest anteriorly.

Flaccidity (3 of 5)
Open phase of vibration now complete. Distance of lateral excursions is large, indicating the flaccidity of cords.

Flaccidity (4 of 5)
The cords are returning to closed vibratory position, but anterior cords close late due to flaccidity. Sometimes this anterior segment vibrates independently and this causes a rough voice quality.

Flaccidity (5 of 5)
At maximum closed phase, there is still a tiny incomplete closure anteriorly.